Montagu Dominic, Chakraborty Nirali
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.
Metrics for Management, Baltimore, MD, United States.
Front Med (Lausanne). 2021 Apr 12;8:624285. doi: 10.3389/fmed.2021.624285. eCollection 2021.
Universal Health Coverage in Low- and Middle-Income Countries is increasingly expanding through incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or part through government-managed health insurance. This underscores the importance of policies on health provision which apply across the whole delivery system regardless of ownership status. To advance understanding of private-sector policies, and to facilitate sharing of lessons across countries with similar public-private distributions, we have analyzed data on the source of inpatient and outpatient care from 65 countries. While past studies have conducted similar analysis, ours advances the field in two ways. First, we limit our analysis to data sets from 2010 through 2019, making our study more up-to-date than past studies, while changing health seeking patterns for maternal health since 2010 means that our data set is more representative of overall inpatient care. Second, while past multi-country analysis of public-private ownership have been based on the Demographic Health Surveys, we have added to this data from the Multiple Indicator Cluster Surveys, significantly increasing the countries in our analysis. We have aggregated our analysis by WHO's regions. Outside of the EURO region, where the private sector delivers just 4% of all healthcare services, the private sector remains significant, and in many countries represents more than half of all care. The private sector provides nearly 40% of all healthcare in PAHO, AFRO, and WPRO regions, 57% in SEARO, and 62% in EMRO. While specific countries with two recent surveys show variation in the scale of both inpatient and outpatient private provision, we did not find regional or global trends toward or away from private care within LMICs. Private inpatient care is most important for the wealthy in many countries; public vs. private care varies less, by wealth, for outpatient services.
通过将私立诊所、药店和医院纳入由政府管理的医疗保险全部或部分资助的整体卫生系统，低收入和中等收入国家的全民健康覆盖范围正在不断扩大。这凸显了适用于整个卫生服务体系（无论所有权状况如何）的卫生政策的重要性。为了增进对私营部门政策的理解，并促进在公私分布情况相似的国家之间分享经验教训，我们分析了65个国家住院和门诊医疗服务来源的数据。虽然以往的研究也进行过类似分析，但我们的研究在两个方面推动了该领域的发展。首先，我们将分析限制在2010年至2019年的数据集，使我们的研究比以往的研究更具时效性，同时自2010年以来孕产妇保健的就医模式发生了变化，这意味着我们的数据集更能代表整体住院护理情况。其次，虽然以往对公私所有制的多国分析是基于人口与健康调查，但我们在此基础上增加了多指标类集调查的数据，显著增加了我们分析中的国家数量。我们按世界卫生组织的区域对分析进行了汇总。在欧洲区域，私营部门仅提供所有医疗服务的4%，而在其他区域，私营部门仍然占据重要地位，在许多国家，其提供的医疗服务占所有医疗服务的一半以上。私营部门在泛美卫生组织、非洲区域、西太平洋区域提供了近40%的所有医疗服务，在东南亚区域为57%，在东地中海区域为62%。虽然最近有两项调查的特定国家在住院和门诊私营医疗服务规模上存在差异，但我们并未发现低收入和中等收入国家存在倾向或远离私营医疗服务的区域或全球趋势。在许多国家，私立住院医疗服务对富人最为重要；就门诊服务而言，按财富划分，公立与私立医疗服务的差异较小。
